Clinical analysis of 6 patients with cardiac surgery under cardiopulmonary bypass during pregnancy / 临床外科杂志

ABSTRACT

Objective To evaluate the optimal management of cardiac surgery during pregnancy,in the second or third trimester,and the maternal and fetal outcomes in pregnant patients after surgery.Methods Six pregnant women with heart diseases were identified,who underwent cardiac surgery with cardiopulmonary bypass.Surgery was performed using cardiopulmonary bypass at mild hypothermia/normothermia,with pulsatile perfusion.Natural progesterone(20 mg)was added in priming solution,monitoring uterine contractions and heart rate changes.The mode of surgeries included mitral valve replacement+tricuspid valve plastic in three cases,aortic and mitral valve replacement+tricuspid valve plastic in one,left ventricular myxomatomy in one,left ventricular septal myectomy+artificial aortic valvular vegetations dissection+tricuspid valve plastic in one.Results The cardiopulmonary bypass and cross clamp time averaged 169 minutes(range,96~419 minutes)and 113 minutes(range,56~296 minutes),respectively.Five patients were alive.One maternal and fetal death occurred 6 h after surgery caused by heart failure and pulmonary edema.The other 5 patients terminated pregnancies after heart surgeries,one underwent with cesarean section 3 d after surgery in second trimester,two of whom with induction of labor,and two full-term labor(one with cesarean section,one with normal delivery).Two newborns were alive with no malformation.Conclusion Cardiopulmonary bypass can be used safely with satisfactory maternal and fetal outcomes in pregnant patients with heart disease undergoing cardiac surgery.